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Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC.
An active 60-year-old woman falls from her attic and presents with the injury in Figure A. She undergoes successful closed reduction and sling immobilization. At follow up, she is unable to move her shoulder. New radiographs are depicted in Figures B and C. What is the next best step?
Continued sling immobilization
Closed reduction percutaneous pinning
Open reduction internal fixation
Reverse total shoulder arthroplasty
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A 48-year-old male returns to your office 8 months after sustaining a proximal humerus fracture that was successfully treated nonoperatively. However he is still having persistent anterior shoulder/arm pain that worsens with most activities. He has not done any physical therapy nor received a corticosteroid injection. What nerve innervates the structure identified by the red arrow in Figure A, what is its primary function, and where does it originate from?
Subscapular nerves, shoulder internal rotation, ventral scapula
Musculocutaneous nerve, forearm pronation, coracoid
Axillary nerve, shoulder external rotation, dorsal scapula
Musculocutaneous nerve, forearm supination, supraglenoid tubercle
Suprascapular nerve, shoulder abduction, dorsal scapula
A 76-year-old left-handed female presents to your office after a fall with the injury seen in Figure A. When treating this fracture with hemiarthroplasty, which of the following is the most important for a successful outcome?
Anatomic healing of the tuberosities
Stem retroversion of 25 degrees
Surgical fixation within 24 hours
Anterior superior labral repair
Age over 75
While snowboarding on the steep slopes in New England, a 56-year-old active right-hand-dominant man falls on his right shoulder and sustains a right proximal humerus fracture. Which of the following fracture characteristics would most directly result in altered rotator cuff biomechanics after closed treatment?
Comminuted medial hinge
Intact calcar length of 6 mm
Greater tuberosity displacement 6 mm
Anatomical neck displacement 8 mm
Surgical neck displacement 9 mm
A 54-year-old woman who is an avid tennis player falls onto her dominant shoulder during a tennis match. Examination reveals tenderness and swelling in the shoulder region, but no neurovascular deficits. Radiographs and CT scan are shown in Figures A through E. Combined cortical thickness is 4.2mm. What is the most appropriate treatment option?
Closed reduction and sling immobilization for 6 weeks
Closed reduction and sling immobilization for 2 weeks followed by early active range of motion exercises
Open reduction and internal fixation
A 31-year-old male sustained a displaced proximal humerus fracture after a motor vehicle accident. Which of the following factors has the lowest association with humeral head ischemia in these injuries?
Neck fracture with a long calcar segment
Disrupted medial periosteal hinge
AO type C3 fracture
When utilizing the pectoralis major tendon as a reference for restoring humeral height during shoulder hemiarthroplasty, at what level cephalad to the proximal edge of the tendon should the top of the prosthesis sit?
A 73-year-old female presents with persistent right shoulder pain 3 months after undergoing open reduction and internal fixation for a right proximal humerus fracture. Which of the following could have best prevented the complication shown in the current radiograph shown in Figure A?
Insertion of both cortical and locking screws into the humeral head
Addition of a 20-gauge intraosseous tension band laterally through the greater tuberosity
Treatment of the fracture with closed reduction and percutaneous k-wire fixation
Addition of an inferomedial locking screw within the calcar
Intramedullary nailing of the fracture
A 64-year-old woman is thrown off a horse, sustaining the injury shown in Figures A and B. She undergoes surgical fixation as seen in Figures C through E. What is the most commonly reported complication of this procedure?
Axillary nerve injury
Valgus migration of the fracture
What structure is 7cm from the acromion and at greatest risk of injury during a deltoid splitting approach for a proximal humerus fracture?
A 46-year-old male is involved in a motor vehicle accident and suffers a proximal humerus fracture. Operative treatment is recommended, and plate fixation is performed through an extended anterolateral acromial approach. Which of the following structures is at increased risk of injury using this surgical exposure compared to the deltopectoral approach?
Posterior humeral circumflex artery
Anterior humeral circumflex artery
A 44-year-old male is struck by a vehicle while riding his bike. In the trauma bay, he complains of right shoulder pain . Upper extremity physical exam reveals no neurologic deficits, and an initial radiograph of the shoulder is shown in Figure A. A CT scan of the shoulder shows 1cm of posterior displacement of the tuberosity fragment. Which of the following is true regarding this injury?
It is usually associated with a posterior shoulder dislocation
The subscapularis muscle is the main deforming force
Non-operative treatment of this displaced injury results in good long term shoulder function
Open reduction and internal fixation is the treatment of choice
Associated rotator cuff tears are uncommon
A comminuted proximal humerus fracture is treated with a shoulder hemiarthroplasty as shown in Figure A. The superior border of the pectoralis major tendon can be used to determine accurate restoration of which of the following?
Humeral prosthesis height and retroversion
Humeral prosthesis offset and retroversion
Humeral prosthesis head-neck angle and height
Humeral prosthesis stem width and height
Humeral prosthesis stem length and retroversion
A 78-year-old female falls and sustains the fracture seen in Figure A. Surgical treatment is pursued with open reduction internal fixation with a lateral locking plate. Postoperative radiographs are provided in Figure B. What is the most common complication with this mode of fixation?
Axillary artery injury
A 60-year-old woman is undergoing closed reduction and percutaneous pinning of a proximal humerus fracture. What structure is at greatest risk for injury from the pin marked by the red arrow in Figure A?
Anterior branch of the axillary nerve
Long head of the biceps tendon
A 45-year-old laborer sustained a fall onto his nondominant shoulder while skiing. His sensation is intact throughout the extremity but he is unable to flex the arm above 90 degrees. A radiograph of his shoulder obtained the next day in the emergency room is shown in Figure A. What is the best treatment option?
Sling and swathe for 6 weeks then physical therapy
ORIF of proximal humerus
Closed reduction and percutaneous pinning of the greater tuberosity
A cadaveric study in 1990 established much of the orthopaedic literature on humeral head vascularity for two decades until recent experiments have provided new data. This original study in 1990 concluded that the anterolateral branch of the anterior circumflex artery supplies blood to what aspect of the proximal humerus?
Anterior portion of humeral head
Entire humeral head except posteroinferior portion of lesser tuberosity and head
Entire humeral head except posteroinferior portion of greater tuberosity and head
Entire humeral head except entire greater tuberosity
A 69-year-old woman falls while getting out of her car and lands on her right shoulder sustaining a 4-part proximal humerus fracture. She subsequently undergoes surgery to treat the fracture, with immediate postoperative radiographs shown in Figure A. Six months following surgery, she denies shoulder pain, but she is unable to actively raise her hand above her shoulder. Which of the following is the most likely cause of this limitation?
Retroversion of the prosthesis
Greater tuberosity malunion
A 74-year-old female trips over the curb in a parking lot and sustains the shoulder injury shown in Figures A and B. An open reduction and humeral hemiarthroplasty is performed. A postoperative radiograph is provided in Figure C. This patient is most at risk for which of the following complications?
Loss of sensation over the lateral shoulder
Reduced shoulder elevation and abduction
Ulnar nerve palsy